Provider Demographics
NPI:1598287062
Name:ALLARD, SAMANTHA EXILDA
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:EXILDA
Last Name:ALLARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 VIRGINIA RD STE 204
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-2769
Mailing Address - Country:US
Mailing Address - Phone:781-674-0000
Mailing Address - Fax:978-347-3712
Practice Address - Street 1:555 VIRGINIA RD STE 204
Practice Address - Street 2:BUILDING 5 , SUITE 204
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2769
Practice Address - Country:US
Practice Address - Phone:781-674-0000
Practice Address - Fax:978-347-3712
Is Sole Proprietor?:No
Enumeration Date:2017-07-16
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
MA20-144817106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist